Earache, or pain in the ear, is common and can occur in both children and adults. It can be due to a problem with the ear or structures close to the ear. The pain may be dull, sharp, or burning and can occur in one or both ears. It may be constant or come and go. 

What Are the Symptoms of Earaches?

Symptoms of earaches in infants and toddlers may include:

• Hearing problems
• Pulling or scratching the ear
• Crying or irritability
• Ear drainage
• Fever

Symptoms of earaches in young children, adolescents, and adults may include:

• Pain
• Hearing problems
• Full or “stuffy” sensation in the ear
• Dizziness or loss of balance
• Nausea, vomiting
• Ear drainage
• Fever

What Causes Earaches?

A variety of problems can cause earaches in children and adults:

• Middle ear infection (called acute otitis media)
• Swimmer’s ear (called otitis externa)
• Temporomandibular joint (TMJ) dysfunction or jaw joint pain
• Eustachian tube dysfunction
• Inflammation of the outer ear (called chondritis)
• Cotton swab use
• Throat infection
• Throat cancer (rarely)

What Causes Earaches in Children?

In children, earaches are commonly due to an infection of the middle ear (acute otitis media), and can affect one or both ears. Otitis media can be serious because the infection can spread to nearby structures in the head, especially the mastoid located behind the ear. Otitis media may also cause hearing loss; in children, it may impair learning ability and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal.

Many cases of otitis media can be treated by your pediatrician or family doctor; more serious cases may need attention from an ENT (ear, nose, and throat) specialist, or otolaryngologist.

Ear infections are often due to eustachian tube dysfunction. Inside your ear you have something called an eustachian tube that equalizes pressure behind the ear drum and naturally clears middle-ear secretions. When the eustachian tube becomes blocked due to a cold, allergy, upper respiratory infection (URI), bacteria, or a virus, negative pressure can develop and mucus can collect behind the eardrum causing pain, swelling, and redness.

What Causes Earaches in Adults?

In adults, common causes of earaches include otitis externa or swimmer’s ear and TMJ dysfunction. Swimmer’s ear is an infection of the ear canal and results from swimming in contaminated water or as a result of cotton swab use. In people with diabetes, otitis externa can spread far beyond the ear canal and can be life threatening. Therefore, prompt treatment with antibiotic ear drops as well as cleaning of the ear canal with specialized tools available to an ENT specialist is critical. Another common cause of ear pain is due to referred pain from the jaw joint. This is usually due to grinding of teeth during sleep. TMJ pain can be treated with ibuprofen, eating softer food, avoiding chewing gum, and using a night guard.

An avoidable cause of earache is the use of cotton swabs or other instruments to clean wax from the ear, which can damage the ear canal. Following the old adage that “nothing smaller than an elbow goes in the ear” can avoid dangerous injury to the ear canal and the eardrum. A rare cause of earache is referred pain from infection or cancer of the throat.

What Are the Treatment Options?

During an examination, your ENT specialist will use an otoscope to look inside and assess your ear. They check for redness in the ear, and/or fluid behind the eardrum, and to see if the eardrum moves. These are the signs of an ear infection. If your hearing is decreased, your ENT specialist may also perform an audiogram to test for any potential hearing loss by presenting tones at various pitches, or a tympanogram, which measures the air pressure in your middle ear to see how well your eustachian tube is working.

Your ENT specialist may also prescribe medications, which must be taken as directed. Often, antibiotics to fight the infection will make your earache go away rapidly, but the infection may need more time to clear up. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both. Sometimes the doctor may recommend a medication to reduce fever and/or pain. Special ear drops can also help ease the pain.

Children who experience multiple episodes of acute otitis media within a short time, chronic otitis media that lasts for more than three months, and/or hearing loss may require the insertion of ventilation tubes, also called pressure-equalization (PE) tubes. This is a short surgical procedure in which a small incision is made in the eardrum, any fluid is suctioned out, and a tube is placed in the eardrum. This tube will eventually fall out on its own, and the eardrum heals.

Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss as well as more severe infections to the surrounding important structures.

What Questions Should I Ask My Doctor?

1. How can I avoid earaches in the future?
2. How do I clean my ears?
3. Can my eustachian tube function be improved?
4. Are ear tubes recommended for preventing ear infections?

Copyright 2021. American Academy of Otolaryngology–Head and Neck Surgery Foundation. Last reviewed April 2020.